Catalyzing a Nursing Response to Healthcare Discrimination Against Transgender and Nonbinary Individuals

Abstract

Globally, it is estimated that 25 million people identify as transgender and nonbinary gender (TGNB). Approximately 1.5 million TGNB adults live in the United States. Under the Affordable Care Act Section 1557 (2011), a federal law was established that made it illegal to discriminate based on "race, color, national origin, sex, age, or disability in certain health programs and activities." Yet, on June 12, 2020, the U.S. Department of Health and Human Services published a new final rule on its interpretation of Section 1557, which remove gender identity or expression from protections included under sex nondiscrimination, thus permitting healthcare discrimination against TGNB individuals. As clinicians, we are deeply troubled by the elimination of gender identity discrimination protections in health care and ongoing violent acts against transgender people. Globally, it is estimated that 25 million people identify as transgender and nonbinary gender (TGNB; Winter et al., 2016), approximately 1.5 million of whom reside in the United States (Kaiser Health News, 2020; Meerwijk & Sevelius, 2017). Transgender is an umbrella term for people "whose gender identity is different from their sex defined at birth," whereas nonbinary refers to a gender expression that is neither male nor female (National Center for Transgender Equality, 2016). Internationally, TGNB persons face significant barriers to accessing appropriate quality health care (i.e., health insurance and limited specialist services) and experience discrimination within healthcare systems (Bakko & Kattari, 2020; Thomas et al., 2017). These barriers to care are reflected in the disproportionate burden of violence and victimization among transgender persons (Johns et al., 2019); insignificant receipt of preventive health screenings (e.g., cholesterol, cancer; Edmiston et al., 2016); and high prevalence of clinical depression, anxiety, somatization, homelessness, and suicide attempts among transgender youth and adults (Keuroghlian, Shtasel, & Bassuk, 2014; Safer et al., 2016). Given the injustices experienced in the healthcare system, discrimination protection laws are necessary to help ensure that TGNB individuals have the fullest civil rights when receiving health care.

School-Based Nurse Practitioners’ Perceptions of the Health Care Needs of Transgender and Gender Nonconforming Adolescents

“…In line with the NASN's (2016) call to action, school-based NPs can advocate for safe environments within their schools through accommodation and the use of affirming gender language. For instance, school-based NPs can help reform school mission and vision statements to use inclusive language and streamline administrative forms to update names and gender identities (Fauer et al, 2020). School-based NPs can continue to support their students by promoting local, state, and federal mandates (e.g., Title IX) that protect the rights of TGNC students and ensure that there are resources available to them through the school if they need them.…”

“…School-based NPs can continue to support their students by promoting local, state, and federal mandates (e.g., Title IX) that protect the rights of TGNC students and ensure that there are resources available to them through the school if they need them. They can also promote legal groups that support TGNC individuals, including the GLBTQ Legal Advocates and Defenders (GLAD), the American Civil Liberties Union, and the Human Rights Watch LGBT Rights (Fauer et al, 2020). Education is another area that needs to be expanded for school-based NPs.…”

“…School-based NPs can improve this gap in knowledge by attending conferences and workshops specific to the health needs of TGNC individuals. Additionally, school-based NPs must necessitate integrating TGNC health into existing training content and nursing curriculums (Fauer et al, 2020). By refining their school climates and raising self-awareness, school-based NPs can help reduce health disparities for TGNC adolescents.…”

Health impacts of climate change on gender diverse populations: A scoping review

“…Stigma and discrimination also complicate data gathering, making population estimates difficult. Globally, some 25 million people and in the United States 1.5 million identify as GD, numbers projected to increase (Fauer et al, 2020; Meerwijk & Sevelius, 2017).…”

“…Globally, health disparities are evident when comparing GD and general populations. Additionally, GD persons experience disproportionate stigma, discrimination (including in healthcare), home displacement, violence, government persecution, and murder (Abeln & Love, 2019; Fauer et al, 2020; White Hughto et al, 2015). While gender‐based violence (GBV) commonly refers to violence toward cisgender women, and is a recognized tool for maintaining traditional gender roles and patriarchal structures, homo‐ and transphobia further compound GBV directed at GD people and populations (Blondeel et al, 2018).…”